A 66 year old man presents with difficulty walking. He describes rigid legs, falling backwards and difficulty standing. He also describes choking on his words and difficulty reading. He denies the presence of trauma

Answer: progressive supranuclear palsy

Comment: although some of these symptoms are consistent with Parkinson’s disease, eye involvement and the absence of tremor are much more closely associated with PSPEMQ 2.

A 45 year old man comes in complaining of uncontrollable flailing of his left arm and leg. He has a history of hypertension, and describes the onset of a severe headache prior to the motor symptoms.

Answer: right subthalamic bleed

Comment: this patient has hemiballismus, usually occurring on the opposite side of the body to the subthalamic bleed which has occurred.

EMQ 3.

A 15 year old indigenous man presents with his parents. They describe severe unco-ordinated rapid jerky movements of both his feet, and both his arms. He has a history of rheumatic fever from the age of 5.

Answer: Sydenham’s chorea

Comment: the history of rheumatic fever suggests Sydenham’s choreaEMQ 4.

A 64 year old man with a history of atrial fibrillation presents complaining of difficulty concentrating. When he is closely questioned he has difficulty naming his fingers, and is unable to count backwards from 100 in units of 7. He also cannot write his own name

Answer: dominant parietal lobe CVA

Comment: these are the symptoms of Gerstman’s syndrome. Non dominant lobe strokes present with hemispheric neglect and dressing apraxia.

EMQ 5.

A 72 year old man is brought in by his wife, who states that he is increasingly confused. She also describes a festinating gait, and says that he has a fine tremor in both hands when he is not moving. On examination he has cog wheel rigidity of all four limbs and diminished facial expressions.